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General NPI Number Information
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NPI Number | 1003260357
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Entity Type | Organization
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Legal Business Name | PENNYFARTHING LLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 520 CEDAR ST STE A
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City | SANDPOINT
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State | ID
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Zip | 83864-1569
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Country | US
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Telephone | 208-255-1617
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Fax |
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Provider Business Mailing Address
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Address Line | 520 CEDAR ST STE A
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City | SANDPOINT
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State | ID
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Zip | 83864-1569
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Country | US
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Telephone | 208-255-1617
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY LOUKUS
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Credential | M.S.
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Telephone | 208-255-1617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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